Transcript Document

Human Milk Bank Processes:
YOUR FACILITY AND LOCATION
Gillian Weaver
Milk Bank Manager
President; European Milk
Bank Association
(www.europeanmilkbanking.com)
[email protected]
@GillyWeaver
Daughter, mother and
breastmilk banker.
Lots more besides
but these three define
me best ....
QCCH Milk Bank
The world’s
longest
continually
operating
milk bank
Our primary goal
93% discharged receiving breastmilk,
60% exclusively breast/breastmilk feeding
Background info
Brief description
How did your human milk bank (HMB) began?
When?
1935 but officially established in1939
Who provided initial funding? How are
ongoing operations funded? Integrated into
government services?
Originally funded by ‘The National Birthday Trust Fund but is now funded by Imperial
College Hospital NHS Trust (ICHNT). Some income is generated by reimbursement of costs
by other hospitals who are provided with donor breastmilk.
Who regulates /oversees HMB in your
country/region (if any)?
NICE guideline – implementation is audited
How many HMBs are part of your system?
Where are they?
17 milk banks in the UK
Is there a central HMB that processes milk
and distributes or many HMBs that process
milk and distribute? (Centralized vs decentralized)
Several are more like a centralised model but most are decentralised.
How many NICU/Neonatal wards/community
homes does each bank serve? Are they
collocated?
It varies between 1 and 36
How many babies does your facility/system
serve annually?
Approximately 400 babies per year at ICHNT
How many liters/year does your
facility/system process annually?
Processes 500 – 700 litres per year.
How many donor mothers initiate donation to
your facility/system annually?
150 +
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A NICE Guideline
Published in February
2010 with:
UNG
QRG
Baseline Assessment
Audit Support
Process
Brief description of processes
Staffing
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1 x full time manager
1 x 0.8wte assistant (mainly administrative)
1 x 0.5wte assistant (mainly technical)
1 x volunteer for 2 hours per week (audit)
Donor recruitment
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Donors contact the milk bank via the UKAMB website (www.ukamb.org), via local
health care professionals or through word of mouth.
Donor screening
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Telephone or face to face initial interview
Detailed health questionnaire via email or post
Blood tests (usually blood taken by local GP and posted to the ICHNT laboratory.
Ongoing screening via health declaration made with each donation.
Recipient eligibility and
selection
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Handling and storage of
donor milk (from donation
to feeding)
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Preterm less < or = to 30/40
More mature babies who meet the pre determined criteria
If in mothers’s home she is required to monitor and record freezer temperature
If stored ina hospital in monitored freezer
In milk bank: stored according to the stage in the milk banking process ie raw milk is
stored separately from pasteurised milk, screened milk is separate from unscreened
milk. All milk is stored separately according to the donor in demarcated and labelled
baskets.
Process
Brief description of process
Transport of milk
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Pasteurization
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Via medical couriers, Via ‘Blood Bikes’ , Milk Bank staff
Use thick walled polystyrene containers sold for the purpose and with detachable
outer carrying case.
Tamper evidence is maintained and milk must be labelled with ID number of mother,
date expressed and any medications taken.
Purpose designed and built human milk pasteurisers (fully automated) with built in
printer and in built milk cooling system.
Have two. Pasteurise in 50ml and 100ml aliquots to prevent wastage.
Tracking and record
keeping
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Assessing milk quality and
safety (ie. microbiology
assays)
Pre pasteurisation
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Every pool of milk (500 – 800mls, single donor only) is tested
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Acceptance criteris are <100,000 cfu’s per ml in total
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< 10,000 cfu’s per ml staphylococcus aureus, enterobacteriaceae
Post pasteurisation
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Sample from every batch should be <100cfu’s per ml.
Quality assurance
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Combination of electronic and paper. Use Excel spreadsheets to maintain records and
to audit activity
HACCP
Audit of implementation of NICE guideline
Double checking and authorisation of all test results
Annual calibration of equipment and follow maintenance schedule
Preparing
to test the
donated
breastmilk
Equipment/Location
Brief description of process
What is used/how many?
• Pasteurizer 2, Freezers 5 in the milk bank (lockable)
• Refrigerators 1 in the milk bank
Additional HMB equipment • 3 Secure rooms (1 only accessed by milk bank staff and 2
only accessed by milk bank or neonatal staff)
requirements?
• 2 Computers
• Printer and label printers
Referral/feeder/depot
facilities?
• Other neonatal units in hospitals within the same
perinatal network (6)
• Equipment requirements – monitored freezers
Neonatal ward equipment
requirements?
• System for tracking usage – no but every container of
DBM has unique ID number and comes with spare self
adhesive number labels that are peeled off and placed in
baby’s medical notes and on separate tracking sheet.
• Freezer and fridge
Other?
• Tamper evident containers, laminar flow cabinet,
insulated transport containers with washable outer cases
Organizational Successes
Brief description of top 3-5 successes
Policy
• Success of UKAMB nationally and UKAMB guidelines
• National guideline funded by Department of Health (NICE guideline
CG93)
• DH Neonatal Toolkit (2009) – recommends access to DBM
• BLISS Standards for Neonatal Care - recommends access to DBM
Operational
• Of the 46 Level 3 Neonatal Units in England the top five in terms of
breastfeeding rates on discharge all have an attached milk bank
• Only 7% of infants are discharged from QCCH NNU (level 3) exclusively
formula fed and 60% are exclusively breastmilk fed.
• Involvement of SERV groups (Blood Bikes – Volunteer motorcyclists,
trained and co-ordinated to collect DBM from donors’ homes and
transport to milk bank and deliver pasteurised donor milk from milk
bank to other neonatal units
• QCCH – longest continually operating milk bank in the world
Technology
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Transporting DBM
SERV (Service by
Rider Volunteers)
Freewheelers
White Knights
Organizational Challenges
Brief description of top 3-5 challenges
Policy
• Developing a robust donor milk use policy that optimises support for
breastfeeding and supports all mothers to provide their own breastmilk
whilst at the same time ensuring stocks aren’t compromised due to too
liberal use nor stocks too plentiful due to too constrained use
Operational
• UKAMB – attracting funding
• QCCH Milk Bank – maintaining consistent demand for DBM from other
hospitals to enable further growth and development of the bank
• Space – very limited and restricts operations
Technology
• introducing electronic testing and reporting systems into the milk bank at
QCCH
•Introducing bar code tracking into the milk bank at QCCH
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Fail proof
identification
and traceability
are essential
components of
the 21st century
milk bank in the
UK
Issuing DBM to the
neonatal units of
Imperial College
Healthcare and to
other hospitals
DONOR BREASTMILK:
A very valuable resource!
Making every drop
count …..
and never forgetting where it all starts....